Severe iatrogenic bismuth poisoning with bismuth iodoform paraffin paste treated with DMPS chelation

Ovaska, Hanna; Wood, David M.; House, Ivan; Dargan, Paul I.; Jones, Alison L; Murray, Shona

doi:10.1080/15563650801953182

Cited by 29 publications

(17 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our patient returned three months after discharge without neurological symptoms. The role of chelators such as D,L-2,3-dimercaptopropane-1-sulfonic acid and 2,3-dimercapto-succinic acid is not well established [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

et al. 2019

View full text Add to dashboard Cite

Background: Drugs containing bismuth, although usually safe, may rarely cause neurotoxicity. Case presentation: We describe the case of a 44-year-old woman treated with bismuth subsalicylate for about 20 years, who developed abnormal behaviour and postural instability in two weeks. On examination, she had greyish discoloration of teeth, was confused and presented generalized myoclonic jerks. In the next days, her clinical condition deteriorated, with a reduction in alertness and more exuberant myoclonus. Brain MRI was unremarkable. CSF revealed mild elevation of protein content (47 mg/dL; reference range: 15-45 mg/dL) and elevation of white blood cell count (10/μL). Bismuth levels in urine (375 μg/L), serum (260 μg/L) and CSF (21.4 μg/L) samples were highly above the threshold for toxicity. Following supportive treatment and bismuth discontinuation, she made a full recovery within weeks. Conclusions: Although rare, bismuth encephalopathy should be considered in patients presenting with subacute encephalopathy and myoclonus. This encephalopathy can be subacute even after a chronic exposure. Cessation of bismuth can lead to a complete resolution in weeks.

show abstract

Section: Discussionmentioning

confidence: 99%

Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

et al. 2019

View full text Add to dashboard Cite

show abstract

“…One case report described clinical deterioration with DMPS and eventual discontinuation of the chelator, [2] while another reported recovery with this therapy [15]. The efficacy of DMPS has not been clearly demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Bismuth Toxicity: A Rare Cause of Neurologic Dysfunction

Reynolds¹,

Abalos²,

Hopp³

et al. 2012

IJCM

View full text Add to dashboard Cite

Bismuth subsalicylate (Pepto-Bismol ® ) and other bismuth-containing compounds have been used for many years to treat gastroenterological complaints. Although safe in the majority of patients, bismuth can cause a well-described toxic state marked by progressive neurological decline. Features of bismuth toxicity include confusion, postural instability, myoclonus, and problems with language [1]. This presentation can masquerade as other causes of progressive neurologic dysfunction including Creutzfeld-Jakob Disease (CJD), Hashimoto's Encephalopathy, and others. In this case study, we present a patient who was using bismuth salicylate in toxic quantities to help control diarrhea. On initial presentation, several diagnoses were entertained before bismuth levels were obtained. This case study highlights the fact that bismuth toxicity, while rare, should be considered in a patient with progressive neurological decline. Also, we hope this case reminds physicians of a severe consequence of a common, readily available medication.Keywords: Bismuth Toxicity; Creutzfeld-Jakob Case ReportA 56 year old woman who had recently begun treatment for collagenous colitis presented to her local hospital with several days of psychomotor retardation, decreased concentration, tremor of her hands, visual hallucinations, and postural instability preventing her from standing on her own. The patient was concurrently being treated on stable doses of medications for irritable bowel syndrome, hypertension, hypothyroidism, and depression.Her husband stated that her concentration had been gradually decreasing for the previous two weeks but had profoundly worsened in the last couple days. There is no record that the patient saw a clinician for mental status deterioration prior to her hospital presentation. During her stay at the hospital, the patient became more delirious and somnolent and began to experience myoclonic jerks and hyperreflexia. Serotonin syndrome was considered, and the patient's serotonergic medications (escitalopram, duloxetine) were held. The patient's lack of improvement over the next three days resulted in transfer to a teaching hospital, where she was admitted to the Neurology Service.Initial physical exam showed temperature 37.0 degrees Celsius, blood pressure 165/94 mm Hg, pulse 117, respirations 16, oxygen saturations 98% on room air. The patient provided one word answers to questions, was lethargic with impaired attention, and could express orientation correctly only to person. Cranial nerves II-XI were intact, but patient could not protrude tongue. Muscle bulk and strength were normal, but tone was markedly rigid throughout. She demonstrated frequent myoclonic jerks and occasionally exhibited intention tremor. Reflex examination demonstrated hyperactive spreading reflexes at all stations with upgoing toes bilaterally. All other aspects of the physical exam were unremarkable. Laboratory tests, including thyroid function tests, B12 levels, RPR, and various microbiological assays were within normal limits. A noncon...

show abstract

“…Removal of amalgam fillings in mercurysensitized patients has been shown to improve general health in patients with chronic fatigue syndrome, fibromyalgia and various autoimmune diseases [89][90][91]. It is also worth mentioning that bismuth, thallium, and metal tin also rarely damage the basal ganglia and have been linked with myoclonus, tremor, chorea, and ataxia, accompanied by psychiatric symptomspsychotic or behavioral disorders or depression [92,93].…”

Section: Mercurymentioning

confidence: 99%

Metals and Parkinson's Disease: Mechanisms and Biochemical Processes

Bjørklund

Stejskal²,

Urbina

et al. 2018

CMC

139

View full text Add to dashboard Cite

Genetic background accounts for only 5 to 10% of the reported cases of Parkinson's disease (PD), while the remaining cases are of unknown etiology. It is believed that environmental factors may be involved in the causality of a large proportion of PD cases. Several PD genes are activated by xenobiotic exposure, and a link between pesticide exposure and PD has been demonstrated. Many epidemiological studies have shown an association between PD and exposure to metals such as mercury, lead, manganese, copper, iron, aluminum, bismuth, thallium, and zinc. This review explores the biological effects, the pathogenetic processes, genetic susceptibilities to metals as well as examining future strategies for PD treatment, such as chelation therapy.

show abstract

Severe iatrogenic bismuth poisoning with bismuth iodoform paraffin paste treated with DMPS chelation

Abstract: DMPS chelation appears to be a potentially effective chelating agent in bismuth toxicity.

Cited by 29 publications

References 12 publications

Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

Bismuth Toxicity: A Rare Cause of Neurologic Dysfunction

Metals and Parkinson's Disease: Mechanisms and Biochemical Processes

Contact Info

Product

Resources

About